新型腰椎经皮椎弓根螺钉植入定位方法及其对放射暴露剂量的影响

An improved method for percutaneous pedicle screw implantation and the effect of the improvement on radiation exposure

目的探讨新型腰椎微创定位方法在定位时间、次数及放射暴露剂量方面的优势。方法2010年5月至2013年2月收治腰椎间盘突出症合并腰椎不稳及胸腰椎骨折121例，随机分为两组：68例采用传统定位方法植入经皮椎弓根螺钉，单节段病变41例、双节段病变27例；53例采用自行研制的腰椎微创定位系统，单节段病变34例、双节段病变19例。两组患者性别、年龄、病程、手术节段的差异无统计学意义。结果传统定位方法组、微创定位方法组术前定位时间分别为（8．26±3．44）min、（3．51±1．82）min，平均定位次数分别为3．57次、1．22次，准确率分别为60．8％及96．2％。两组单节段病变患者植入双枚经皮椎弓根螺钉，术中定位时间分别为（15．12±4．69）min、（5．51±1．32）min，定位次数分别为6．47次、2．45次；双节段病变患者植入三枚经皮椎弓根螺钉，术中定位时间分别为（24．91±7．43）min、（8．84±2．32）min，定位次数分别为11．72次、3．69次。传统定位方法组手术人员颈部、胸部及手腕部检测出的放射暴露剂量分别为（3．09±0．24）Gy、（4．23±．71）Gy、（5．17±0．62）Gy，微创定位方法组分别为（1．38±0．47）Gy、（2．69±0．33）Gy、（3．21±1．05）Gy。两组定位时间、定位次数及放射暴露剂量的差异有统计学意义。结论腰椎微创定位系统及定位方法能够简化手术操作，具有定位准确性高、定位时间短、透视次数少、医护人员及患者接受x线射线暴露量低的优点。

Objective To introduce a new minimally invasive lumbar positioning system and its positioning method as well as conduct a prospective control study on the differences in positioning time, positioning frequency and radiation exposure dose between the new positioning method and the traditional positioning method. Methods 121 patients with lumbar disc hernia- tion combined with lumbar instability and patients with thoracolumbar vertebral fracture admitted in our hospital from May 2010 to February 2013 were randomized into two groups. 68 patients in Group A had undergone the traditional positioning method be- fore and during operation. Among the 68 patients, 41 were with single-segment lesion and 27 were with two-segment lesion. 53 pa- tients in Group B had undergone the new minimally invasive lumbar positioning system before and during operation. Among the 53 patients, 34 were with single-segment lesion and 19 were with two-segment lesion. There were no significant differences in gender, age, course of disease and other general information between the two groups. The positioning time, positioning frequency and radia- tion dose of the two groups before and during operation were compared and statistically analyzed. Results The positioning time of Group A and Group B were 8.26±3.44 min and 3.51±1.82 rain respectively; the positioning frequencies were 3.57 and 1.22; the accuracy were 60.8% and 96.2%. For the patients with single-segment lesion, the positioning time before implanting two percuta- neous pedicle screws during operation were 15.12±4.69 min and 5.51 ±1.32 min respectively and the positioning frequency were 6.47 and 2.45. For the patients with two-segment lesion, the positioning time before implanting three percutaneous pedicle screws during operation were 24.91±7.43 rain and 8.8±2.32 min respectively and the positioning frequency were 11.72 and 3.69. More- over, the radiation dose detected at neck, chest and wrist of the surgical staff in Group A were 3.09±0.24 Gy, 4.23±0.71 Gy and 5.17±0.62 Gy and that detected in Group B were 1.38±0.47 Gy, 2.69±0.33 Gy and 3.21±1.05 Gy. There were significant differenc- es in positioning time, positioning frequency and radiation dose between Group A and Group B. Conclusion The minimally inva- sive spine positioning system and positioning method can simplify the operative procedures and largely reduce radiation exposure, which is characterized by high positioning accuracy, short positioning time, low fluoroscopy frequency and X-ray radiation dose.